Date of Trust Board: 29 October 2014 REPORT TO PUBLIC TRUST BOARD

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1 REPORT TO PUBLIC TRUST BOARD NAME/TITLE OF DIRECTOR AUTHOR OF REPORT SUBJECT Lindsey Webb, Chief Nursing Officer Sonya Murray, Associate Chief Nurse Workforce & Education Recruitment & Retention EXECUTIVE SUMMARY/KEY POINTS This paper outlines the Trust s Nursing & Midwifery Recruitment & Retention. The document sets out the strategic direction in which nursing & midwifery will work towards recruiting and retaining the best skilled and dedicated people who are signed up to our vision, values and standards. It highlights how the Trust can become an employer of choice, enabling staff to provide excellent patient care. Following the appointment of the Interim Director of Workforce and OD this strategy and associated actions will be further developed. STRATEGIC PRIORITIES ( ) 1 Deliver safe, high quality, compassionate patient care 2 Design healthcare around the needs of our patients with our partners 3 Invest and realise the full potential of our staff providing personalised and compassionate care 4 Ensure the Trust is financially viable and makes the best use of resources for our patients 5 Develop and sustain our business RECOMMENDATION The Board is asked to: Receive the recruitment and retention strategy. Note the actions being taken to improve recruitment and retention across our Workforce. BOARD ACTION REQUIRED ( ) Decision Action Assurance Please tick box to confirm that the report takes account of the NHS Constitution Page 1 of 14

2 IMPLICATIONS Service quality and delivery including patient safety/experience and clinical effectiveness Financial Risk Board Assurance Framework risks Workforce Legal & Governance Statutory or External Assessor requirements Impact assessments Equality IA Quality IA Reduced staffing levels as a result of an inability to recruit or retain sufficient numbers skilled staff will impact on patient quality and safety. The inability to recruit or retain staff will increase the Trusts financial spend on bank and agency staff 2678 Reduced staffing levels as a result of an inability to recruit or retain sufficient numbers skilled staff will impact on patient quality and safety. NA That Trust ensure Safe Staffing levels are a requirement of the National Quality Board/CQC NA APPROVAL PROCESS Paper approved/meeting: Date 20 October Page 2 of 14

3 Nursing & Midwifery Recruitment and Retention RECRUITMENT AND RETENTION STRATEGY NURSING & MIDWIFERY Page 3 of 14

4 Contents 1. Introduction Page 3 1. Why do we need a strategy Page 3 2. Intended outcomes of the strategy Page 4 3. Key objectives Page 5 4. Building a Professional Reputation Page 6 5. Improving the recruitment process Page 6 6. Recruitment challenges Page 7 7. Innovative recruitment solutions Page 7 8.Targeted recruitment campaigns Page 9 9. Engaging with academic Institutions Page Growing nursing and midwifery numbers Page Temporary workforce Page Developing current staff Page Improving staff work experience Page 12 Summary Page 13 Action Plan Page 14 (available on request) Page 4 of 14

5 INTRODUCTION The NHS is undergoing a period of significant and rapid change and is constantly in the spotlight. The recruitment and retention of nursing and midwifery staff remains a huge challenge to ensure the NHS meets key targets and the modernisation agenda for the health service, including the lessons learnt from the Francis and other reports. We need to ensure the recruitment of high calibre staff who exhibit the key skills and experience to undertake their job roles effectively and demonstrate the right attitudes and behaviours to deliver compassionate care. Worcestershire Acute Hospitals NHS Trust (WAHT) needs to employ more staff and improve how it retains, manages and develops its existing workforce. At the same time ensuring that our workforce continues to be at the levels to provide safe and effective care. The demographic realities of an ageing nursing & midwifery workforce and the increasingly attractive career opportunities outside the NHS make the recruitment and retention of staff one of the biggest challenges the NHS faces. This document sets out the strategic direction in which nursing & midwifery will work towards recruiting and retaining the best skilled and dedicated people who are signed up to our vision, values and standards. It highlights how WAHT can become an employer of choice, enabling staff to provide excellent patient care. Trust employees are required to have the right range of skills, experience and qualities to meet the demands of an evolving business and customer focused organisation. The Trust aims to attract, retain and develop a skilled and flexible Nursing & Midwifery Workforce that is committed to delivering high quality, safe and compassionate care. The strategy also sets out the initiatives that are in place and/or need to be implemented for nursing and midwifery staff across the Trust in order to achieve the long term business aims and objectives. 1.0 Why we need a strategy? The shortage of candidates with the right skills, abilities and experience in some areas of nursing and midwifery has created a competitive market. The ability to deliver high quality, compassionate care depends upon recruiting and retaining the right people with the right skills. The Nursing & Midwifery workforce are key to the success of Trust values, strategic goals and objectives, therefore an effective recruitment and retention strategy that complements the overall Recruitment and Retention and the Trust business plan is essential. A strategy is required to address these issues and to focus on recruitment to those areas with significant vacancy levels. The Trust is at potential risk due to the challenges of attracting, recruiting and retaining a high calibre and skilled workforce in areas which nationally are hard to recruit to e.g. Neonatal, Emergency Medicine and Theatres. This Recruitment and Retention will outline actions being taken to minimise these risks. A number of other workforce changes including service re-configuration and changes to the medical workforce staffing will see the need to develop new and innovative nursing and midwifery roles in the future. Page 5 of 14

6 2.0 Strategic direction and context intended outcomes of the strategy This document outlines the strategic direction in respect of the Recruitment and Retention initiatives for Nursing & Midwifery within the Trust over the next three years. It provides guidance on key objectives and in addition provides a summary of the activities that are currently being undertaken in support of that direction as well as highlight how some of these will be further developed over the course of the strategy period. This strategy compliments and should be read in conjunction with the wider Trust Recruitment and Retention. The intended outcomes of this strategy are as follows: 1. WAHT will recruit high caliber nurses and midwives, to ensure the provision of safe integrated care and high level clinical services within the acute environment. 2. WAHT will manage its nursing and midwifery staff talent effectively so that it always has the right staff and skill mix to be able to respond speedily and effectively to necessary changes. 3. Nursing & Midwifery staff work effectively in their roles and find their working life with WAHT to be an enjoyable and rewarding experience. Flexible patterns of work will be encouraged and managed in the context of Trust objectives. 4. Nursing & Midwifery staff do not leave WAHT because of failings in relation to their working conditions and the quality of their working experience. 5. Nursing & Midwifery Staff are loyal to WAHT, understand and are committed to its aims, and remain in its employment for as long as this provides mutual benefit. 6. High performing Nursing & Midwifery staff becomes the norm for WAHT through its approach to the recruitment, development, rewarding and retention of staff. 7. Poor performers will be equally managed through the Trust supportive policy frameworks to ensure improved performance or that this is appropriately managed if this is not achieved. 3.0 Key objectives of the strategy Ensuring nursing and midwifery establishments are in line with RCN and NICE recommendations and best practice with regards to staff to patient ratios and service delivery needs. This will result in a reduction in the Trusts dependency on temporary agency and bank staff and therefore reduce overall workforce costs as well as ensure the provision of consistent high quality care. Page 6 of 14

7 Raise the profile of the Trust as the place to work and be treated through engagement with Universities, schools, colleges and other organisations through activities such as work experience programs, careers conventions, and healthcare apprenticeships. To be the employer of choice for nursing and midwifery students from local Universities. Ensure a regular and consistent flow of both trained nurses and midwives and untrained healthcare workers to meet vacancy needs as a result of on-going recruitment in areas of high turnover and hard to recruit areas. Continue to recruit nurses internationally where relevant and appropriate to complement other UK and local recruitment campaigns and initiatives. Maximise efficiency of recruitment through the use of centralised assessment centres for all nursing and midwifery posts. Elevate the Trust corporate brand amongst key audiences by professional corporate branding and high quality promotional material. In response to staff feedback improve the efficiency and dispel perception of the recruitment process being lengthy and with unnecessary delays. Reduce the time taken to recruit and fill a vacancy. Develop new roles and innovative new ways of working in order to reskill and flex our nursing and midwifery workforce to deliver care in different ways and in different settings. Monitor recruitment activity and outcomes and produce management information to illustrate such activity in partnership with recruitment and workforce information teams. improving overall job satisfaction for our nursing and midwifery staff through ensuring regular opportunities for feedback and valuing and developing our staff, their working environment and improving our retention 4.0 Building a Professional Reputation In order to become an employer of choice for nursing and midwifery in the region and nationally and have a positive image within the local and wider community we will: Develop a Trust wide annual recruitment planner which is proactive and has a co- ordinated sustainable through-flow pipeline of candidates in the recruitment process linked to the Trust s Workforce Plan which will focus on Divisional and Directorate needs. Page 7 of 14

8 Improve service standards throughout the recruitment process by evaluating selected recruitment campaigns. We will survey applicants at the end of the campaign and obtain feedback from recruiting managers and new starters. The results will be evaluated and the process revised appropriately. Develop, review and promote a standard advert templates that will reenforce the values of the Trust. The Trust currently uses the NHS jobs site to advertise all its vacancies. Review the quality and presentation of recruitment materials and develop literature regarding career opportunities within the Trust. Ensure exemplar activity in respect of recruitment practices, and processes and its approach to the support, development and management of staff by ensuring effective HR support and input that adds value to the organisation. Ensure appropriate marketing of the achievements of the nursing and midwifery workforce through Trust News local, national and international journals and other media, conferences and networking. Developing an efficient and effective temporary nursing and midwifery staffing service that meets the needs of the organisation 5.0 Improving Recruitment Process WAHT is committed to professional and responsive recruitment processes to assure that the right skill mix is secured and maintained. There are a number of things that can be done to enhance the current recruitment process. Systems can be introduced that will better support managers throughout the recruitment process, reduce the administrative burden and bottlenecks in the system. Review processes and develop performance indicators to ensure time-scales are kept to a minimum. Recruitment will be managed as a speedy and streamlined process to minimise the possibility of loss of good candidates to other organisations and to optimise the future relationship between the successful candidate and the Trust. Time to recruit will be a key performance indicator. Ensure recruitment is values based and reflects national practice based frameworks such as the 6CS. Use occupational testing as part of the Recruitment and Selection process where appropriate and ensure where used they continue to remain fit for purpose. Page 8 of 14

9 Ensure all staff involved in the recruitment process have recruitment and selection training. Continue developing an assessment center approach for all nursing and midwifery staff Establish a system to utilise good candidates who have been interviewed but not appointed in the first instance. When similar jobs become vacant this database of staff can be managed via a waiting list system- used before going out to advert. Ensure that a key component of the recruitment process will be the identification by the selection panel of any candidate s development needs, both immediate and longer term. In order to ensure that jobs are well designed, the following work will be required : Developing guidance on job design for managers Undertaking a review of all vacancies that are not filled and those that are vacated within a year to ensure jobs are designed well. 6.0 Recruitment Challenges Recent service developments have highlighted that there is a limited pool of people in some professions, making successful recruitment increasingly difficult. The Trust currently faces challenges recruiting nursing staff to the following areas: Emergency Departments countywide Neonatal Nurses county wide Emergency Medicine at Worcestershire Royal Hospital Theatres countywide Surgery at the Alexandra Hospital These hard to recruit areas will be given priority when running recruitment campaigns. 7.0 Innovative recruitment solutions improving the way we advertise It is anticipated that more sophisticated advertising of nursing and midwifery posts could result in raising the profile of the Trust, attracting good quality candidates and reducing costs. Detailed below are strategies the Trust will employ to get better value for money and improve the effectiveness of advertising: WAHT will advertise the majority of posts on the NHS Jobs. However, we will exercise flexibility where either: Page 9 of 14

10 The applicants will have an exceptional skills base. The applicants would normally be drawn from the local community e.g. healthcare assistants. The applicants may not easily have access to an electronic application system. Or posts where it is felt that based on past experience NHS Jobs has not produced the caliber of candidates required. The use of social media options will normally have little or no associated costs and is immediate, hence this could be a cost effective way to recruit to some posts. Investing in recruitment events can be another option as this can leave a positive impression on candidates and give them an opportunity to ask questions. Any such events should be followed up to track candidates who attend and/or apply for vacancies so that it is possible to monitor the effectiveness of such an event against positive outcomes. Over time this will allow the Trust to build its own database of potential candidates who can be specifically targeted at a later date should a suitable vacancy arise. The Trust will run corporate generic recruitment campaigns for nursing and midwifery at regular intervals throughout the year to ensure a regular supply of potential candidates to fill on- going/anticipated vacancies and establish an on-going presence in the job market place. Develop a recruitment website which promotes the Trust as a good employer. All adverts will point to this site where information about the organisation will be promoted. This will link to the Trust s jobs on the NHS jobs site. Improve the quality of adverts, using branded adverts and developing a set of standard adverts that will re-enforce the values of the Trusts PRIDE values promises. The HR Recruitment and Communications teams will support recruiting managers to take ownership for copy-writing adverts, ensuring they meet the corporate image Advertise using composite adverts, rather than for individual jobs Review the nursing and midwifery recruitment booklet that gives an overview of the organisation and details the benefits of working for WAHT. 8.0 Targeted recruitment campaigns For those areas which have a high vacancy rate due to national shortages such as we will run focused campaigns. These will include: Development of a recruitment microsite Vacancy and Directorate specific recruitment literature Page 10 of 14

11 Ensuring a Trust presence at profession specific and generic events locally and nationally Open days for specific professions 9.0 Engaging with academic Institutions The Trust will continue to engage with academic institutions such as schools, colleges and universities in the area by, attending careers events and job fairs both locally and nationally where appropriate, providing information about working in the NHS and for WAHT, promoting careers in nursing and midwifery and inspiring college and university leavers to consider healthcare as a serious career choice thus engaging with the potential younger workforce and ensuring a future pipeline of healthcare workers 10.0 Growing nursing and midwifery numbers 10.1 Developing the un-registered workforce The Trust will continue to second un-registered staff from their substantive posts to salary supported nursing and midwifery student status. When the successful staff complete their degrees and qualify WAHT will ensure that all secondees are recruited into vacant staff nurse posts. If a post is unavailable then a vacant HCA post will be found until such time as a suitable staff nurse post becomes available to apply. Decreases in the number of student nurse commissions will be supported by a nursing and midwifery workforce plan that supports HCAs in a developmental career path to becoming a qualified nurse. The Trust supports work experience where it is part of a structured programme of learning and/or as part of a programme to rehabilitate/introduce long term unemployed into the job market and improve their chances of employability. We also continue to develop the number of health care apprentices we recruit. We will continue to develop to develop our existing substantive healthcare assistant workforce through apprenticeships, implementation of the certificate fundamental care certificate and the higher care certificate as outlined in the Cavendish review will also be designated the Trust Year of the Healthcare Support Worker. There will be a series of events and initiatives introduced to demonstrate the Trusts commitment to retaining and developing this group and staff and recognising their significant contribution to high quality care for all our patients Return to Practice ( RTP) Health Education West Midlands (HEWM) is currently leading on a national RTP initiative and the Trust is participating in this The benefits of a RTP programme are: Page 11 of 14

12 Low attrition rates Local nurses wanting employment with their clinical placement provider at the end of the course Often nurses with many years of previous experience Often more mature nurses who bring wider experiences Unlikely to go on career break, and more likely to work until retirement More cost effective than training a nurse from scratch Following approval by the Nursing & Midwifery Council ( NMC) of a RTP programme at the University of Worcester the following actions will be undertaken : Joint promotional events with the University for potential recruits. Identification of a Trust Lead for RTP. Joint values based recruitment to the programme. Employment by the Trust as a HCA prior to and during the course. Employment by the Trust following successful completion of the course New roles In recognition of the impact of service re-design on workforce there has been an increasing nurse staffing levels in the two Emergency Departments at AGH and WRH to deal with increased attendances. We have commissioned 10 ENP places at Worcester University to enable service redesign and less reliance on locum middle grade doctors due to the national shortage. A number of other roles are being implemented and developed which not only enhance the patient experience but are attractive to staff providing both opportunities for staff to progress and specialise and diversify. These include specialist dementia posts, advanced nursing roles, role s combining clinical and non-clinical functions such as education and quality assurance Overseas recruitment The Trust is considering a range of option for overseas recruitment both in partnership with HEWM and independently. This will consider opportunities for recruitment within Europe and wider afield Temporary Workforce Temporary staff will remain a part of the nursing and midwifery workforce of the future and the Trust continue to recruit high quality temporary workers to maximise the availability of temporary staff and build greater flexibility in the workforce as well as provide a pool of staff that can move into permanent posts if appropriate will undertake regular reviews of the service that provides temporary staff across the Trust to ensure the service continues to meet the needs of the Trust and its customers and is fit for purpose. This will include: Scoping the potential of an in-house bank or agency master vendor provider to support the Trust s temporary staffing needs when any gaps in skills/workforce needs cannot be met internally and to provide value for Page 12 of 14

13 money. An enhanced E- Rostering system which will link to bank and agency providers platforms to allow better deployment of temporary nursing and midwifery staff. Participation in regional joint recruitment opportunities overseas 12.0 Developing our current staff WAHT encourages internal movement and makes a number of internal appointments. In order to make this process easier and more effective we need to develop systems to better manage this process, in line with the Trusts Organisational Development and the Trusts Leadership and talent management strategies. Appropriate systems will be developed, tailored to meet the needs of each staff group. These will include developing competency based progression for staff Leadership Development Programmes for staff across all bands up to and including senior nursing and midwifery management Supporting and ensuring access to leadership and development programmes specifically for nursing and midwifery staff Use of Occupational Testing e.g. Management Development 13.0 Improving staff work experience One of the main elements of the strategy is to improve the quality of the work experience and become an employer of choice. The national staff survey provides useful information on how staff view their work experience and enables benchmarking against other Trusts and our competitors. The Trust aims to develop and review policies and initiatives including developing appropriate action plans to address concerns and issues raised by staff in order to support and encourage all staff to recommend WAHT as a place to work or be treated. All staff have the right to work in an environment which is conducive to effective working practices and which ensures they can work safely and healthily. The following actions in a number of different areas will be required in achieving this Improve the physical working environment for staff. Continue to ensure our staff feel safe in their workplace. Regularly monitor sickness absence and ill health retirement to identify underlying causes. Develop a control of working hour s policy to ensure compliance with the European Working Time Directive. Regularly review rostering practices. We will also continue take the opportunity to learn from other employers, both NHS and externally about best practice in the retention of staff whilst think creatively about how to value the contribution of our staff. The Trust intends to implement the Page 13 of 14

14 following ideas to The design and award of a hospital badge for those staff who successfully complete the HCA Fundamental skills programme (which will become the Fundamental Care Certificate) and higher level training. The design and award of a hospital badge for nurses and midwives to recognise the efforts of staff that demonstrate the highest levels of clinical standards, knowledge and professionalism. Newly recruited staff to be invited to meet with Chief Nursing Officer 3 months after appointment to reflect on their welcome and induction to the organisation. Senior nurses and midwives sponsoring student cohorts during their training programmes from induction to completion. Divisions to set up quarterly forums for staff to give feedback on their work life experiences. SUMMARY This strategy sets out the many challenges facing the Trust in achieving its aim of recruiting and retaining a nursing and midwifery workforce with the requisite skills, within an environment which supports flexible and healthy working practices and professional development to make the Trust an employer of choice. The challenges are significant but we are confident that with the participation and commitment of nurses and midwives at every level, the Trust will achieve and maintain a skilled and dedicated workforce representative of the local community, and capable of delivering high quality, safe and compassionate patient care to the people of Worcestershire In summary this covers both Recruitment and Retention and the short, medium and long term objectives for the workforce in relation to how it attracts, develops and retains its workforce. Whilst the current NHS Reforms and uncertain economy may cause some anxiety amongst staff, The Trust recognises that unless we have an appropriately skilled and motivated workforce, we will not be able to deliver our strategic and operational objectives and deliver the best possible care to our patients, their families and the community we serve. To this end WAHT is committed to retaining its best staff to deliver quality care with improved outcomes for patients and a continual service improvement plan which supports its PRIDE values to the people of Worcestershire. Page 14 of 14

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